Health Care

Recent amendments to the Pennsylvania Medical and Osteopathic Practice Acts have changed the supervisory physician’s countersignature requirements for patient records completed by a physician assistant.

Previously, supervising physicians have been required to countersign all patient records completed by a physician assistant within a reasonable time, not to exceed 10 days. Under Acts 100 and 101 of 2013, which went in to effect at the end of January 2014, supervising physicians now have option to ease the countersignature requirement. Under the amendments to the Medical and Osteopathic Practice Acts, a physician is permitted, if he or she chooses, to review only a selected number of patient records completed by a physician assistant.

The number of records selected by a supervising physician must be of a sufficient quantity to “assure adequate review of the physician assistant’s scope of practice.” The supervising physician and physician assistant must establish written criteria upon which the supervising physician would select patient records for review. The patient records reviewed by the supervising physician must be of a sufficient number to assure adequate review of the physician assistant’s scope of practice. The Medical and Osteopathic Practice Acts still mandate that a supervising physician abide by the “100% countersignature within 10 days” requirement during the following time periods:

• the first 12 months of a physician assistant’s practice post-graduation and after obtaining licensure;
• the first 12 months of a physician assistant’s practice in a new specialty;
• the first 6 months of a physician assistant’s practice in the same specialty under a new primary supervisor (unless, the new primary supervisor was registered as a Substitute Supervisor for at least 6 months under another written agreement).

Upon expiration of these time periods, the supervising physician will no longer be subject to the 100% chart review requirement. In opting to deviate from countersigning all physician assistants’ records, a supervising physician is required to complete and submit a Written Agreement Change Form with the State Board of Medicine or the State Board of Osteopathic Medicine, as applicable. The Written Agreement Change Form must include specific details including, but not limited to, the number and frequency of patient record reviews required and the criteria for selecting patient records for review.

A Written Agreement Change Form can be found on the Medical Board’s website at www.dos.state.pa.us/med or the Osteopathic Board’s website at www.dos.state.pa.us/ost. The State Boards of Medicine and Osteopathic Medicine have also instituted a new process for physician assistants to obtain a “temporary authorization to practice” upon submission of an application, the Board’s staff will review the application only for completeness and issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. A temporary authorization for the physician assistant to begin practicing will not be issued if the application is deemed not “complete” where, for example, required signatures or other information is missing or a fee is not included, etc.

It is important that the application be completed correctly to avoid rejection by the Board. If any discrepancies in the application are not resolved after 120 days, the physician assistant must stop working. While these changes in the Medical and Osteopathic Practice Acts offer supervising physicians the option to greatly reduce countersignature requirements, the, that may not be the case in a hospital or other health care facility setting. Countersignature requirements in a hospital or health care facility are also under the jurisdiction of the hospital/facility bylaws, the Pennsylvania Department of Health’s Health Care Facility Act and The Joint Commission.

For example, the Health Care Facilities Act requires that medication or treatment be administered only upon “written and signed orders of a practitioner acting within the scope of his license and qualified according to medical staff bylaws.” (28 Pa. Code § 107.61). Such facility requirements can be more restrictive than state law. Practitioners should consult the appropriate medical staff office, hospital or facility compliance office to assure com